Drug abuse

There are many different reasons why people experiment with drugs, whether it is out of curiosity, to ease stress or depression, because their friends are doing it, or in an attempt to improve physical performance. Often this behaviour is a one-off or an infrequent activity that people dip in and out of; however, in some cases using drugs can lead to abuse. This is by no means automatic and there is no specific point at which drug using becomes an addiction.

Ultimately the spiral from casual use into drug addiction varies from person to person, and there are often several other factors at play contributing to an individual's dependence on the drug(s). It is when this dependence starts interfering with the 'normality' of life - affecting a person's relationships, health, well-being and their performance at school or work - that they are considered to be fully immersed in the negative cycle of drug addiction.

What is drug abuse?

Drug abuse is an unhealthy dependence on a medication or drug that usually begins with the voluntary taking of drugs. It is characterised by an intense psychological and physical dependency that develops when persistent use of drugs triggers changes in the brain. These changes challenge a person's self-control and gradually limit their ability to resist intense cravings to take the drugs. In the more advanced stages of drug addiction, overwhelming withdrawal symptoms can develop which keep people trapped in the negative cycle. Even when their habit starts causing them and their loved ones serious harm, people with drug addiction cannot control or stop their drug using.

Recent statistics show that around nine in 1000 people have a drug addiction, yet a vast majority of these will be unaware that their drug use has escalated to levels of addiction. There is generally a very fine line between drug abuse and regular use, but very few people are able to recognise when they cross the line - especially if they do not use drugs very frequently. Essentially drug addiction is more to do with the consequences of drug use rather than the frequency of which someone uses drugs. Regardless of how much or how little someone is using, if drugs are impacting their life - relationships, work, education, health and well-being - they are very likely to have an addiction.

Overcoming drug abuse can be very difficult and most people will require help in the form of specialised drug treatment. This typically involves a combination of withdrawal therapy, counselling and self-help groups, although the exact methods used will depend on the individual and the nature of their addiction. Treatment for drug abuse can only be successful if an individual is ready and willing to change. It can take a lot of courage and strength to face up to an addiction, but recognising that you need help is the first important step to a successful recovery.

What drugs can people become addicted to?

There are many different types of drugs, and they can be referred to as hard or soft, legal or illegal, uppers or downers or addictive and non-addictive. Drugs can also be categorised based on their side effects. These vary from stimulants, depressants and hallucinogens.

Stimulants

As the name suggests, stimulants increase alertness - boosting brain activity and elevating heart rate and respiration. These drugs are typically prescribed to treat health conditions such as ADHD and occasionally depression, but there are illegal kinds that people use to feel more energised and more confident. Examples include cocaine, ecstasy, amphetamines and nicotine.

Depressants

In contrast to stimulants, depressants slow down the functioning of the central nervous system. They are typically prescribed to help treat anxiety and sleep disorders, but some people may start misusing them as their body becomes accustomed to their effects. Examples include alcohol, solvents, barbiturates, tranquillisers and heroin. Common negative side effects of misuse include impaired coordination, balance and judgement.

Hallucinogens

These drugs modify perceptions of reality - changing the way users experience the world through their senses. Examples include cannabis, magic mushrooms, LSD and ketamine, and the effects can be highly unpredictable. Often users will see and hear things that are not real and some will experience psychotic reactions such as paranoia.

Recreational and prescription drugs

It is also worth noting that drugs can be categorised based on how people use and obtain them. Typically drugs are either recreational or prescribed. Recreational drugs are chemical substances taken for pleasure and typical examples include alcohol, tobacco, caffeine, and illegal substances such as cocaine and ecstasy. Prescription drugs on the other hand are specifically provided for medical purposes. They are over-the-counter medicines recommended and prescribed by a doctor such as pain relievers and sedatives. These can be addictive if used in a manner that is not advised on the labelling.

Misuse of Drugs Act 1971

Due to the unpredictability and severity of effects some drugs can have, a classification system was put in place by the Misuse of Drugs Act 1971 to penalise users, producers and sellers of particular substances. These drugs are placed into one of three classes - A, B or C - which reflect the level of harm they can cause either to the user or to society when they are abused. Class A drugs (heroin, cocaine, methadone, LSD, ecstasy etc.) are considered the most likely to cause serious harm.

Causes of drug abuse

There is no single reason why someone may become addicted to drugs. Some people who use drugs will have a very low risk of developing a dependency, whilst others may be more vulnerable due to a number of contributing factors. As with many diseases, the causes of drug abuse are a combination of factors such as individual biology, age, stage of development, environmental and social factors. It is also worth noting that the accessibility to certain substances and the method of taking them - particularly smoking and injecting - can increase addictive potential of drugs.

Biological factors

Experts believe some people are genetically predisposed to addiction, and that specific environmental factors can enhance this vulnerability. The presence of mental health issues such as depression and anxiety are also thought to influence the risk of drug abuse, particularly if an individual has resorted to prescription drugs to ease troublesome symptoms and make them feel more 'normal'.

Environmental factors

People with a family history of addiction or who have experienced abuse, neglect or other traumatic experiences in childhood are more likely to fall into patterns of drug abuse. These are just a snapshot of some of the environmental influences that can increase a person's vulnerability to drug addiction. Peer pressure, stress and quality of parenting can also influence drug use, especially as taking substances can for many fill a void and/or fulfil a valuable need - i.e. an escape from painful thoughts and feelings.

Development

The above influences will interact with critical stages of development in a person's life to increase their vulnerability to drug abuse. Although drug abuse can develop at any age, the earlier drug use begins the more likely it will progress into addiction. This is because in young people and adolescents, areas of the brain governing judgement, decision making and self-control are still developing. As a result they are more prone to taking risks, such as drug using.

How do drugs affect the brain?

As aforementioned, taking drugs can negatively impact the brain. This is because chemicals in drugs affect the brain's communication system by disrupting the way nerve cells normally send, receive and process information. There are two distinct ways in which drugs can have this effect - either by imitating the brain's chemical messengers and/or by over stimulating the brain's 'reward' circuit.

Drugs such as marijuana and heroin are responsible for 'fooling' receptors in the brain and causing nerve cells to send abnormal messages around the body. This is because they have a similar chemical structure to neurotransmitters in the brain. In contrast, drugs such as cocaine trigger the nerve cells to release abnormally large amounts of neurotransmitters (i.e. dopamine), or cause them to prevent the normal recycling of these chemicals. As a result the brain is overwhelmed with dopamine which is responsible for emotion, motivation and feelings of pleasure. The over stimulation of this reward system produces euphoric responses and sets in motion a pattern that drives people to repeat the rewarding drug taking behaviour.

Signs of drug abuse

Because it can be hard for drug users to recognise when their habit has escalated beyond control, often it is friends and family of people with drug addiction that are the first to notice signs of drug abuse. People with drug addiction will be so focused on getting a fix - often out of desperation to relieve cravings and avoid unpleasant withdrawal symptoms - that they will be unable to see the reality of their situation, and that their health and well-being could be at risk.

Although different drugs will have different physical effects, generally signs of drug abuse are quite similar. Below is a list of the warning signs of drug abuse you should look out for if you are concerned about someone you know.

Physical signs of drug abuse

Deterioration of appearance and neglected grooming.

Unusual smells on the breath, clothing and/or body.

Bloodshot eyes and/or pupils looking larger or smaller than normal.

Changes in sleeping patterns and/or appetite.

Sudden weight-loss or weight gain.

Slurred speech.

Impaired coordination.

Lack of concentration.

Vomiting, tremors, sweating (common signs of withdrawal symptoms).

Behavioural signs of drug abuse

Sudden and unexplained financial problems - may be resorting to stealing.

If you suspect that a friend or family member has a drug problem, you need to address the situation as sensitively as possible. Try talking to the person about your concerns and suggest the option of treatment. It is very likely that people with drug addiction will be very defensive of their situation - in denial of how bad their drug use has become - so it is important that you do not become frustrated. Remember that you cannot force someone to change - you must simply let them accept responsibility for his or her actions whilst providing as much encouragement and support as possible. Hopefully they will see the need to face up to their problem and if this is the case help them to arrange an appointment with their GP. Here they will be diagnosed and offered the appropriate treatment available to begin their recovery.

Treatment for drug abuse

Treatment for drug abuse typically involves organised treatment programmes that include counselling, withdrawal therapy and self-help groups to help people overcome their addiction and resist using the drug in the future. The exact methods of treatment however will vary between individuals according to their personal needs and level of drug addiction.

In some cases a rehabilitation programme will be needed to help people who are dealing with severe addiction. For others, counselling is a highly effective means of recovery. Talking and behavioural therapies are most commonly used and these can be carried out in group or individual therapy. Sessions will be focused on teaching clients new ways of coping with drug cravings, whilst helping to tackle coexisting problems (if necessary) such as depression and anxiety. Cognitive behavioural therapy is often used for treating drug abuse as it enables people to recognise feelings, thoughts and situations that cause drug cravings. The therapist aims to help them avoid these triggers and replace negative thoughts and feelings with ones that are healthier.

Withdrawal therapy involves gradually reducing the dose of a drug and replacing it with other substances to help decrease a person's dependency. Methadone is a commonly used substitute which has less severe side effects than other drugs. During this phase of treatment people with drug addiction are likely to experience the unpleasant withdrawal symptoms that come with giving up a drug, but support groups can provide a valuable source of compassion, understanding and motivation to help them stay committed to recovery and ultimately drug free.

What should I be looking for in a counsellor or psychotherapist?

Whilst there are no laws stipulating a required level of training for counsellors working with drug addiction, the National Institute for Health and Care Excellence (NICE) have put together some clinical guidelines outlining recommendations about psychological treatments, treatment with medicines and what kind of services help individuals with a drug addiction.

Key recommendations suggest that people in drug treatment should be offered psychosocial or psychological treatments, which may include:

Behavioural therapy in which the person agrees with their therapist a set of consequences and rewards for using and not using drugs (known as contingency management).

Couples and/or family therapy.

Psychological treatments such as cognitive behavioural therapy (CBT).

Depending on the nature of the drug addiction and the drug in question, detoxification may also be offered.

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